Woo M S, Woo M A, Gozal D, Jansen M T, Keens T G, Harper R M
Division of Neonatology and Pediatric Pulmonology, Childrens Hospital of Los Angeles, CA 90054-0700.
Pediatr Res. 1992 Mar;31(3):291-6. doi: 10.1203/00006450-199203000-00020.
Heart rate variability was assessed in 12 patients with congenital central hypoventilation syndrome (CCHS) and in age- and sex-matched controls using SD of time intervals between R waves (R-R intervals), R-R interval histograms, spectral analysis, and Poincaré plots of sequential R-R intervals over a 24-h period using ambulatory monitoring. Mean heart rates in patients with CCHS were 103.3 +/- 17.7 SD and in controls were 98.8 +/- 21.6 SD (p greater than 0.5, NS). SD analysis of R-R intervals showed similar results in both groups (CCHS 102.2 +/- 36.0 ms versus controls 126.1 +/- 43.3 ms; p greater than 0.1, NS). Spectral analysis revealed that, for similar epochs sampled during quiet sleep and wakefulness, the ratios of low-frequency band to high-frequency band spectral power were increased for 11 of 12 patients with CCHS during sleep, whereas a decrease in these ratios was consistently observed in all controls during comparable sleep states (chi 2 = 20.31; p less than 0.000007). During wakefulness, the ratios of low-frequency band to high-frequency band spectral power were similar in both patients with CCHS and controls. Poincaré plots displayed significantly reduced beat-to-beat changes at slower heart rates in the CCHS patients (chi 2 = 24.0; p less than 0.000001). The scatter of points in CCHS Poincaré plots was easily distinguished from controls. All CCHS patients showed disturbed variability with one or more measures. The changes in moment-to-moment heart rate variability suggest that, in addition to a loss of ventilatory control, CCHS patients exhibit a dysfunction in autonomic nervous system control of the heart.
采用动态监测法，通过测量R波间期（R-R间期）的标准差、R-R间期直方图、频谱分析以及连续R-R间期的庞加莱图，对12例先天性中枢性低通气综合征（CCHS）患者及年龄和性别匹配的对照组进行心率变异性评估，监测时长为24小时。CCHS患者的平均心率为103.3±17.7标准差，对照组为98.8±21.6标准差（p>0.5，无统计学意义）。R-R间期的标准差分析显示两组结果相似（CCHS组为102.2±36.0毫秒，对照组为126.1±43.3毫秒；p>0.1，无统计学意义）。频谱分析表明，在安静睡眠和清醒状态下采集的相似时段中，12例CCHS患者中有11例在睡眠期间低频带与高频带频谱功率之比增加，而在可比睡眠状态下，所有对照组均观察到这些比值下降（卡方=20.31；p<0.000007）。在清醒状态下，CCHS患者和对照组的低频带与高频带频谱功率之比相似。庞加莱图显示，CCHS患者在心率较慢时逐搏变化明显减少（卡方=24.0；p<0.000001）。CCHS庞加莱图中的点散布情况与对照组易于区分。所有CCHS患者均表现出一种或多种测量指标的变异性紊乱。心率逐时变化表明，除了呼吸控制丧失外，CCHS患者在心脏自主神经系统控制方面存在功能障碍。
